14 THE NOSE AND PARANASAL SINUSES
the nasopharynx, a mirror image of which is seen in the glass. When performed
successfully (Fig. 14), a view is obtained of the posterior end of the nasal
septum, which is seen as a pale vertical ridge. On either side the posterior
nares, or choanae, are seen, and the posterior ends of the three conchae are
visible. Laterally the tubal ridges surrounding the pharyngeal ends of the
auditory tubes come into view. In the roof of the nasopharynx one may see
adenoid tissue, or occasionally a dimpling within a small ridge denotes the
pharyngeal recess (fossa of Rosenmuller).
Nasopharyngoscopy may be undertaken through an electrical naso-
pharyngoscope which is made on the principle of the cystoscope. It is usually
necessary to anaesthetize the floor of the nose with cocaine before using this,
and, as with all endoscopies, considerable practice and experience are
necessary before the examiner becomes proficient.
In children examination of the nose is easily accomplished by tilting up the
tip of the nose with the thumb and directing the light along the nasal cavities.
Examination of the nasopharynx is not easy without frightening the child,
and should be reserved for the older age group. If it is unsuccessful at the
first attempt it should not be persisted with. The barbarous habit of digital
palpation of the nasopharynx in the conscious child has fortunately been
abandoned. Digital palpation may be performed with ease and accuracy under
anaesthesia when the nature of any swellings may be determined and dealt
with at the same time. Much information regarding the child's nasopharynx
may be obtained from lateral radiography.